2 Use in Health Behavior Theories

Worry per se, whether assessed as a trait or as a temporary
feeling, has been ignored by all health behavior theories.
Of course, affect in the form of feelings (as opposed
to "affective judgments") does not appear in most health behavior
theories. No mention of feelings is made in these commonly
used theoretical approaches to health and behavior: the Health
Belief Model (Hochbaum,
1998xClose
Hochbaum, G. M. (1958). Public participation in medical
screening programs: a socio-psychological study. Washington,
D.C.: U.S. Dept. of Health, Education, and Welfare. ),
the Theory of Reasoned Action (Fishbein
& Ajzen, 1975xClose
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention,
and behavior: an introduction to theory and research.
Reading, Mass.: Addison-Wesley, 1975. ) (and its extension,
the Theory of Planned Behavior, Ajzen,
1991xClose
Ajzen, I. (1991). The theory of planned behavior. Organizational
Behavior and Human Decision Processes, 50, 179-211. ),
and the Transtheoretical Model (DiClemente
et al., 1991xClose
DiClemente, C.C., Prochaska, J.O., Fairhurst, S.K., Velicer,
W.F., Velasquez, M.M., & Rossi, J.S. (1991). The process of
smoking cessation: An analysis of precontemplation, contemplation,
and preparation stages of change. Journal of Consulting
and Clinical Psychology, 59, 295-304. ).

Three models do explicitly acknowledge the potential role
of feelings. The first model was introduced by Ronald Rogers
(e.g., Rogers
& Prentice-Dunn, 1997xClose
Rogers, R.W., & Prentice-Dunn, S. (1997). Protection motivation
theory. In David S. Gochman (Ed.), Handbook of Health
Behavior Research. Vol.1. New York: Plenum Press, pgs
113-132. ) to explain how people respond to threatening
messages. In the model, called Protection Motivation
Theory, emotion is produced by the interaction of
two perceptions created by the message: the severity of the
health threat and one's vulnerability to the health threat.
Thus, the threat of lung cancer could cause fear among people
who a) know about the short life expectancy for people with
the disease and b) feel at personal risk because of their
smoking behavior. Rogers was interested in when people are
motivated to protect themselves from a health threat, and
it is interesting to note that he did not provide any role
for fear as a contributor-one way or the other-to self-protective
motivation. Instead, he proposed that the cognitions did the
work and fear was merely present. In a recent meta-analysis
of variables in the theoretical model, the authors neglected
to discuss fear, illustrating the minimal causal importance
they attached to the construct (Floyd,
Prentice-Dunn, & Rogers, 2000xClose
Floyd, D.L., Prentice-Dunn, S., & Rogers, R.W. (2000). A meta-analysis
of research on protection motivation theory. Journal of
Applied Social Psychology, 30, 407-429. ).

A second theoretical approach explicitly provided a role
for emotions in health behavior. Specifically, Leventhal's
Common-Sense Model of Health and Illness Self-Regulation
(Leventhal,
Brissette, & Leventhal, 2003xClose
Leventhal, H., Brissette, I., & Leventhal, E. A. (2003). The
common-sense model of self-regulation of health and illness.
In L.D. Cameron & H. Leventhal (Eds.), The self-regulation
of health and illness behaviour (pp.42-65). London: Routledge.
) suggests that a health threat prompts parallel motives
to cope with the a) threat itself and b) emotions caused by
the threat. Thus, in Leventhal's approach, emotion
is motivating. Some authors include a variety of
emotions in Leventhal's model, but Leventhal's initial ideas
arose out of his research on fear messages for communicating
threat (cf. Cameron,
2003xClose
Cameron, L.D. (2003). Anxiety, cognition, and responses to
health threats. The common-sense model of self-regulation
of health and illness. In L.D. Cameron & H. Leventhal (Eds.),
The self-regulation of health and illness behaviour
(pp.42-65). London: Routledge. ). In keeping with those
initial ideas, Witte
(1998)xClose
Witte, K. (1998). Fear as motivator, fear as inhibitor: Using
the extended parallel process model to explain fear appeal
successes and failures. In P.A. Anderson and L.K. Guerrero
(Eds.), Handbook of Communication and Emotion: Research,
Theory Applications, and Contexts. 423-450. Academic
Press. identified fear as the crucial emotion
in her discussion of an "Extended Parallel Process
Model"(an extension of Leventhal's common-sense model).
Witte predicted that when people are exposed to a threatening
message, they will do something to ameliorate the threat,
if possible; otherwise, they will experience fear. In the
latter case, according to Witte, people will be motivated
to reduce the negative emotion but not necessarily by engaging
in self-protective actions. Both Leventhal and Witte would
suggest that emotion drives actions, with slightly different
theoretical twists. For Leventhal, expectations about the
affective outcomes of the self-protective behavior (will cancer
screening make me feel better?) determine the course of action;
for Witte, expectations about one's ability to perform the
self-protective behavior (can I easily obtain a cancer screening?)
will determine the course of action. In both cases, however,
low levels of emotionality will not be motivating.

The third approach that acknowledges feelings is Suzanne
Miller's Cognitive Social Health Information Processing
(C-SHIP) model (Miller,
Shoda & Hurley, 1996xClose
Miller, S. M., Shoda, Y., & Hurley, K. (1996). Applying cognitive-social
theory to health protective behavior: Breast self-examination
in cancer screening. Psychological Bulletin, 119,
70-94. ). Miller considers many feelings in her model;
worry is just one of many potential reactions in decision
making about health behaviors. Miller et al. also propose
that the relationship between worry and behaviors will depend
on the intensity of emotionality, with either very low or
very high levels of worry impeding action. This proposal is
also known as a "curvilinear" or "inverted U-shaped" hypothesis,
and is prominently embedded within the model. The notion of
a curvilinear relationship between emotion and behavior is
an old idea in psychology (Teigen,
1994xClose
Citation needed ). It is worth noting that existing
empirical evidence is much more likely to support a linear,
positive relationship between worry and self-protective behaviors
(McCaul
& Mullens, 2003xClose
McCaul, K.D., & Mullens, A.B. (2003). Affect, Thought, and
Self-Protective Health Behavior: The Case of Worry and Cancer
Screening. In J. Suls and K. Wallston (Eds.), Social Psychological
Foundations of Health and Illness, Blackwell: Malden,
MA. ; Hay,
McCaul, & Magnan, 2006xClose
Hay, J.L., McCaul, K.D., & Magnan, R.E. (2006). Does worry
about breast cancer predict screening behaviors? A meta-analysis
of the prospective evidence. Preventive Medicine,
42, 401-408.). Part of the problem with the curvilinear
hypothesis is that it is imprecise. For example, it is unclear
how to define "very high levels of worry." Miller et al. also
suggest that high worry can lead to both avoidance of a self-protective
response but also excessive performance of the response,
without explaining when one behavioral solution is more likely
to be adopted than the other. Finally, it is important to
acknowledge that Miller's theory is one of the few to explicitly
incorporate individual differences (though not dispositional
worry, which deserves greater theoretical attention).